Pain Patterns Research Articles

Stress and recurrent abdominal pain.

We discuss the aetiology of recurrent abdominal pain of non-organic origin, according to the Rome Criteria for Functional Gastrointestinal Disorders and a psychogenic hypothesis. Stress activates the brain-gut axis, which is important for local gut symptoms, such as abdominal pain, but it also causes pain in other areas, including the head, back and chest. Our research has indicated that the startle reflex plays a dominant role in this stress-induced pain pattern, which is manifested in the whole body. Localised abdominal pain can be part of a general negative stress reaction that causes multiple pains in other areas of the body.

Anesthetic Effect of 2% Amitriptyline Versus 2% Lidocaine: A Comparative Evaluation.

Introduction A common dental problem is the fear of pain during needle prick for giving local anesthesia (LA). The needle prick pain during dental procedures oftenvaries with sex andage. Perception of pain depends on various factors, which can be psychological and biological. This perception of pain may change the behavior of patients toward dental treatments. Traditionally, lidocaine gel formulation was utilizedbefore the parenteral dosage form. The lidocaine gel formulation is considered the drug of choice for LA in dental surgery. Currently, amitriptyline has been utilized in dental practice because of its beneficial pharmacology. Hence, the present study has been undertaken to compare the anesthetic ability of amitriptyline as an intraoral topical anesthetic agent with lidocaine gel. Methods This study was a comparative clinical study between two medications' anesthetic properties. This study included 120 patients indicated for bilateral orthodontics (the subdivision of dentistry that emphasizes identifying necessary interventions for the malocclusion of teeth) procedures. All the subjects were divided into amitriptyline and lidocaine groups. Both anesthetic gels wereapplied at separate sites before the injection of LA. The time of the onset of anesthesia was noted and analyzed. Patients were selected on the basis of inclusion and exclusion criteria. Individuals aged 18 to 30 years who were systemically healthy and orthodontically indicated for bilateral premolar extraction were included in this study. Again, patients with a history of neurological disorders and allergies to amitriptyline and lidocaine were excluded fromthe current study. Results Significant differences emerged between groups at five and 10 minutes, with amitriptyline-inducedpartial numbness (36.7% and 6.7%). At 40 and 45 minutes, both groups showed varied partial and complete numbness, with amitriptyline leading to partial recovery (23.3% and 73.3% complete numbness, 23.3% partial recovery) and lidocaine resulting in partial recovery (81.7%). When comparing the visual analog scale (VAS) scores, both groups exhibited a similar simultaneous effect at 15 minutes. Nonetheless, amitriptyline displayed significantly lower scores at 25 and 35 minutes (p < 0.001) in comparison to lidocaine. Similar observations were made when controlling for pain intensity. Conclusion It was concluded that amitriptyline holds both anesthetic and analgesic properties. Nevertheless, this study was unable to generalize the study findings because of the small sample size and being a single-center study. However, the VAS scores of anesthetic and analgesic pharmacodynamics properties of amitriptyline were statistically significantly lower than lidocaine, particularly at 25 and 35 minutes. Additionally, amitriptyline-induced anesthetic and analgesic pharmacology, especially pharmacokinetics properties, depends on the location and pattern of pain.

Evaluation of Subclinical Left Ventricular Systolic Dysfunction By Global Longitudinal Strain Using 2D Speckle Tracking Echocardiography in Angina With Normal Epicardial Coronary Arteries

Background: Global longitudinal strain (GLS), assessed by 2D speckle tracking echocardiography (2D-STE), may offer a valuable non-invasive method to assess subclinical left ventricular (LV) systolic dysfunction in patients with chest pain but normal epicardial coronary arteries. The primary objective of the study was to detect subclinical LV systolic dysfunction by GLS using 2D-STE in patients with angina with normal coronary arteries and conventional echocardiograms at baseline. Methods: This was a comparative case–control study that included patients with complaints of an ischaemic pattern of chest pain despite normal coronary arteries (cases) and healthy individuals (controls). Resting LV systolic function was assessed by transthoracic echocardiography and GLS using 2D-STE analysis. The results of all three planes in GLS (the apical four-chamber, two-chamber, and three-chamber views) were combined in a single ‘bull’s eye’ summary (agreeing with the standard 17-segment model), which presented the analysis of each segment along with a global peak systolic strain value for the LV. Results: The study included 120 participants (60 cases and 60 controls). The normal reference value of the mean GLS in the control group was −19.7 ± 1.84%. GLS assessed by 2D-STE was significantly impaired in patients with angina-like syndrome with normal epicardial coronary arteries (−18.78 ± 1.87 versus −19.7 ± 1.84%; p&lt;0.007) compared with the control group despite preserved LV ejection fraction. In the case group, GLS reduced significantly in eight patients (13.3%) than control group. Conclusion: Patients with angina with normal epicardial coronary arteries are likely to have microvascular disease. GLS assessed by 2D-STE has the potential to improve the value of echocardiography in coronary microvascular disease detection. Despite normal LV ejection fraction, significant impairment of LV global longitudinal systolic function can differentiate a microvascular group of patients from others who have angina with normal coronaries.

PREVALENCE AND PATTERNS OF NEUROPATHIC PAIN IN A COHORT OF PATIENTS WITH CHRONIC POST-SURGICAL PAIN AFTER TOTAL KNEE ARTHROPLASTY

AbstractIntroductionTotal knee replacement (TKR) is a successful operation for many patients, however 15–20% of patients experience chronic post-surgical pain (CPSP). Many will experience neuropathic characteristics.We describe the prevalence and patterns of neuropathic pain in a cohort of patients with CPSP three months after TKR.MethodologyBetween 2016–2019, 363 patients with troublesome pain, ≤14 on Oxford Knee score pain subscale, at three months after TKR from eight NHS hospitals were recruited into the Support and Treatment After Replacement (STAR) trial. Self-reported neuropathic pain was assessed at three, nine and fifteen months after surgery using painDETECT and Douleur Neuropathique 4 (DN4).ResultsAt three months post-operative, 53% reported neuropathic pain on painDETECT and 74% on DN4. Half (56%) remained in neuropathic pain over the twelve-month follow-up period, 26% reported improvement, and 9% reported new neuropathic symtpoms or fluctuated in and out of neuropathic pain (9%). Overall mean neuropathic pain scores improved between three and 15 months after TKR. When the painDETECT cut-off score of ≥13(ambiguous/possible) was used, DN4 and painDETECT measures showed similar prevalence rates at each timepoint.ConclusionNeuropathic pain is common among patients with CPSP at three months after TKR. Although symptoms improved over time, one quarter to one half of our cohort continued to report symptoms at fifteen months. We propose a painDETECT cutoff score of ≥13 be used to identify neuropathic features in the TKR population. Postoperative care should include identification, assessment, and treatment of neuropathic pain in patients with CPSP after TKR.

Diagnosis of epigastric pain: a case report

Epigastric pain is the most significant symptom and a major clinical challenge in chronic pancreatitis. Pancreatic pain is characteristically described as a constant, severe, dull, epigastric pain that often radiates to the back and typically worsens after high-fat meals. However, many different pain patterns have been described, ranging from no pain to recurrent episodes of pain and pain free intervals, to constant pain with clusters of severe exacerbations. A 30-years old female inpatient with complaints of abdominal pain located on epigastric since 7 days ago. Patients also complain of nausea and vomiting, decreased appetite. The patient has a history of acute pancreatitis and was treated 6 months ago and is hyperthyroid. Physical examination within normal limits. On abdominal examination, there was tenderness in the epigastric part. Abdomen ultrasound examination revealed widening of the pancreatic duct. While hospitalized the patient was treated with meropenem 1 gram IV every 8 hours, pantoprazole 40 mg IV every 12 hours, ondansetron 8 mg IV every 12 hours, Kaltrofen supp if needed, Propranolol 5 mg PO every 12 hours and thyrozol 10 mg PO every 12 hours. Acute pancreatitis is an acute, non-bacterial inflammation of the pancreas organ. Radiographic examination must be done to establish diagnose beside anamnesis and laboratorium examination. To diagnose acute pancreatitis, at least 2 of 3 criteria must be met. Management of patients with acute pancreatitis includes non-operative and surgical. Antibiotics therapy in management of acute pancreatitis in the early stages is still controversial.

Back pain and radicular pain after lumbar microdiscectomy

PurposeIt is generally expected that lumbar microdiscectomy affects radicular leg pain, but not so much local back pain. The primary objective was to evaluate if the trajectories of changes in pain severity follow similar patterns for back and radicular leg pain after lumbar microdiscectomy. The secondary objective was to investigate the associations between some preoperative parameters and the patterns of these trajectories.MethodsRegister-based retrospective study of 353 patients undergoing microdiscectomy in the lumbar spine. Linear mixed modelling was applied.ResultsThe average age of the participants was 46 years and 44% were women. The developmental trajectories were similar for both back and leg pain. Pain level decrease during the first year after the surgery, slightly worsening later. No statistically significant interactions were detected of preoperative pain duration or severity, sex or age on the shapes of the trajectories. For every analyzed grouping factor, the 95% confidence intervals overlapped at every postoperative time point with one exception – worse preoperative back pain was statistically significantly associated with worse pain at three months and at the end of the two-year follow-up.ConclusionAfter microsurgical discectomy, developmental curves for both back and radicular leg pain demonstrated similar patterns. Pain intensity decreased during the first year after the surgery. and slightly increased after that remaining, however, below the preoperative level. Age, sex, preoperative pain duration or preoperative intensity of leg pain were not associated with significant differences in the trajectories of pain severity after the surgery. In this study, severe preoperative back pain was the only factor, which was significantly associated with worse postoperative trajectory of pain intensity.

Pain in Trauma Patients: Measurement and Predisposing Factors

IntroductionAcute pain is common after injury. This study intended to evaluate the feasibility of quantifying pain experience over an entire admission using “area under the pain curve” and to identify factors associated with increased pain. MethodsThis retrospective single-center study included all trauma patients admitted from 2013 to 2020. Maximum pain scores were extracted for each day. Pain was defined as area under the curve (AUC) of maximum pain scores/day plotted against time. Injury patterns were analyzed by dichotomizing Abbreviated Injury Scale (AIS) scores (AIS < 3 versus AIS ≥ 3) for each body region. Urinary drug screen results were collected from admission data. A general linear model was used to determine which injury patterns, mechanisms, and age groups were predictive of increased AUC in all patients together and separate by operative and nonoperative groups. ResultsWe identified 21,640 patients, of which 70% were male and 83% had suffered blunt injury. Overall injury severity was associated with increased pain experience. Serious head injury, younger age, and older age (compared to 45-49 y) were associated with decreased pain. Spinal injuries, thoraco-abdominal injuries, and combined thoracic and lower extremity injuries were predictive of increased pain. Compared to patients with no positive test for illicit substances or documentation of prehospital narcotic medications, the pain experience was greater for both, those who had been administered a narcotic in the prehospital setting and those who tested positive for illicit substances. ConclusionsThis study extends the concept of total pain experience using AUC methodology. Our results demonstrate associations between increased pain and certain patterns of injury, ages, and presence of drugs on admission. Measuring total pain experience could assist in comparing pain-management strategies. Future research should focus on validating pain experience against quality-of-life measurements.

Pre-Trauma Pain Is the Strongest Predictor of Persistent Enhanced Pain Patterns after Severe Trauma: Results of a Single-Centre Retrospective Study.

Background and Objectives: Traumatic injuries are a significant public health issue worldwide, with persistent enhanced pain being a common complication following severe trauma. Persistent and chronic pain can have a profound impact on patients' quality of life, affecting physical, emotional, and social functioning. This study aimed to investigate the pain patterns of trauma patients before and after severe trauma, and identify the predictors of persisting pain after injury. Materials and Methods: A total of 596 patients of a level-one trauma centre with severe trauma were included in this study. The Trauma Outcome Profile Scale was used to assess pain severity before and after trauma, and a logistic regression analysis was performed to determine the most significant predictors of relevant pain after severe trauma. Results: The mean age of the included patients was 48.2 years, and 72% were males. The most frequent cause of injury was traffic accidents, and the mean Injury Severity Score was 17.6. Nearly half of the patients experienced reduced pain-related quality of life after trauma, with persisting pain predominantly occurring in the neck, spine, shoulder, pelvis, hip, knee, and feet. Even minor injuries led to increased pain scores. Preexisting pain before injury (OR: 5.43; CI: 2.60-11.34), older age (OR: 2.09, CI: 1.22-3.27), female gender (OR: 1.08, CI: 0.73-1.59), and high injury severity (OR: 1.80, CI: 1.20-2.69) were identified as significant predictors of enhanced pain. Conclusions: These findings highlight the importance of considering pre-existing pain, body area, and injury severity in assessing the risk of persistent pain in trauma patients.

Efficacy of postural awareness by booklet on back pain among the sweet makers

Background: The purpose of the study was to identify the efficacy of postural awareness by a booklet on back pain among sweet makers. Objective was to explore socio-demographic (age, gender, educational status, occupation) characteristics of sweet-makers with back pain. To compare the rating of pain intensity before and after postural awareness by a booklet with the back pain of sweet-makers. Methods: This study was conducted by pre-test post-test experimental study in which a total of 25 sweet-makers were selected with back pain from January 2021 to December 2022. Data were collected by using the functional rating index questionnaire to evaluate the activity of daily living and pain measured by the visual analogue scale questionnaire. Statistical package for the social sciences (SPSS) was used for data analysis. Results: In this study, the results showed significant improvement in the reduction of back pain and increase functional activities of daily living by postural awareness with an educational booklet among sweet-makers. The NPRS score in pair sample t-test before and after 15 days of postural awareness by booklet was the level of significant 0.000123, the mean of 0.640±0.700. The pattern of pain before and after 15 days of postural awareness by booklet was the level significant 0.042896 when the mean difference was -0.160±0.374. The referred pain before and after 15 days of postural awareness by booklet was 0.000032 level significant where the mean difference was -0.520±0.510. Conclusions: The result of this study suggests that postural awareness through a booklet on back pain was effective and it also improves activities of daily living among sweet-makers.

Clinical relevance of deep learning models in predicting the onset timing of cancer pain exacerbation

Cancer pain is a challenging clinical problem that is encountered in the management of cancer pain. We aimed to investigate the clinical relevance of deep learning models that predict the onset of cancer pain exacerbation in hospitalized patients. We defined cancer pain exacerbation (CPE) as the pain with a numerical rating scale (NRS) score of ≥ 4. We investigated the performance of the deep learning models using the Matthews correlation coefficient (MCC) with different input lengths and time binning. All the pain records were obtained from the electronic medical records of the hematology-oncology wards in a Samsung Medical Center between July 2016 and February 2020. The model was externally validated using the holdout method with 20% of the datasets. The most common type of cancer was lung cancer (n = 745, 21.7%), and the median CPE per day was 1.01. The NRS pain records showed circadian patterns that correlated with NRS pain patterns of the previous days. The correlation of the NRS scores showed a positive association with the closeness of the NRS pattern of the day with forecast date and size of time binning. The long short-term memory-based model exhibited a good performance by demonstrating 9 times the best performance and 8 times the second-best performance among 21 different settings. The best performance was achieved with 120 h input and 12 h bin lengths (MCC: 0.4927). Our study demonstrated the possibility of predicting CPE using deep learning models, thereby suggesting that preemptive cancer pain management using deep learning could potentially improve patients’ daily life.

Temporal stability in the prevalence and pattern of co-occurring musculoskeletal pain among people with persistent low back pain: population-based data from the Norwegian HUNT Study, 1995 to 2019.

People with persistent low back pain (LBP) often report co-occurring persistent musculoskeletal (MSK) pain in other body regions that may influence prognosis as well as treatment approaches and outcomes. This study describes the prevalence and patterns of co-occurring persistent MSK pain among people with persistent LBP based on consecutive cross-sectional studies over 3 decades in the population-based HUNT Study, Norway. The analyses comprised 15,375 participants in HUNT2 (1995-1997), 10,024 in HUNT3 (2006-2008), and 10,647 in HUNT4 (2017-2019) who reported persistent LBP. Overall, ∼90% of participants in each of the HUNT surveys with persistent LBP reported persistent co-occurring MSK pain in other body sites. The age-standardized prevalence of the most common co-occurring MSK pain sites was consistent across the 3 surveys: 64% to 65% report co-occurring neck pain, 62% to 67% report shoulder pain, and 53% to 57% report hip or thigh pain. Using latent class analysis (LCA), we identified 4 distinct patterns of persistent LBP phenotypes that were consistent across the 3 surveys: (1) "LBP only," (2) "LBP with neck or shoulder pain," (3) "LBP with lower extremity or wrist or hand pain," and (4) "LBP with multisite pain," with conditional item response probabilities of 34% to 36%, 30% to 34%, 13% to 17%, and 16% to 20%, respectively. In conclusion, 9 of 10 adults in this Norwegian population with persistent LBP report co-occurring persistent MSK pain, most commonly in the neck, shoulders, and hips or thighs. We identified 4 LCA-derived LBP phenotypes of distinct MSK pain site patterns. In the population, both the prevalence and pattern of co-occurring MSK pain and the distinct phenotypic MSK pain patterns seem stable over decades.

Aging exaggerates pulpal pain sensation by increasing the expression levels of nociceptive neuropeptides and inflammatory cytokines

BackgroundDental pain is a main clinical problem in the elderly population and its assessment and treatment make special challenges for health care services. However, the age-induced alteration in dental pain perception and the underlying molecular mechanism(s) has not yet been fully clarified. MethodsHere, the effect of aging on nociceptive behaviors following inflammatory dental pulp pain was evaluated. Since prostaglandins, nociceptive neuropeptides, and inflammatory cytokines have critical roles in the development of aging as well as pain signaling, the expression levels of COX-2, CGRP, IL-1β, IL-6, TNF-α and its converting enzyme TACE were assessed in the trigeminal ganglion of young and aged rats with dental pain. Dental pulp pain was induced by intradental application of capsaicin (100 μg). The immunofluorescence (COX-2 and CGRP) and western blot techniques were used. ResultsThe data showed that aged animals have different pattern of pain. So that, the mean of nociceptive scores was significantly greater in aged rats at 10 and 15 min after capsaicin injection. In aged rats, dental pain was persisting over 7 h, while it was disappeared at 300 min in young rats. Molecular data showed that dental pain significantly increased the expression of COX-2, CGRP, IL-1β, IL-6, TNF-α and TACE in the trigeminal ganglion of the young and aged rats. In addition, the amount of those parameters, except TACE, in capsaicin-treated aged animals were significantly (p < 0.05) greater than those in capsaicin-treated young rats. ConclusionIt seems that the induction of pro-inflammatory cytokines in an acute inflammatory pulpal pain model may contribute, at least in part to the increased nociceptive behaviors and pain perception in aged rats.

The Association of Diabetes with Knee Pain Severity and Patterns in People with Knee Osteoarthritis

The Association of Diabetes with Knee Pain Severity and Patterns in People with Knee Osteoarthritis

Predictors of pelvic pain in a general urology clinic population.

To assess the prevalence and predictors of chronic pelvic pain in a general urology population presenting for evaluation of unrelated non-painful complaints.Generalized pelvic pain is estimated to afflict between 6% and 26% of women and is often multifactorial in aetiology. A paucity of prospective research exists to characterize chronic pelvic pain patterns and to understand related predictors. This is a prospective, cross-sectional survey-based study of female patients presenting to a general urology clinic over a 10-month period (7/2018-5/2019). Patients completed a 32-item survey with questions pertaining to demographics, comorbidities and chronic pelvic pain characteristics. Comparison tests (chi-squared, Fisher's exact) and stepwise multivariable logistic modelling were performed to assess for predictors of chronic pelvic pain. A total of 181 women completed the survey, with a mean age of 56 years. Overall, 75 (41%) women reported chronic pelvic pain. Those with chronic pelvic pain were younger compared to those without (52 vs 59 years, p= 0.001). Univariable logistic regression analysis identified BMI, depression, fibromyalgia, overactive bladder and any bowel symptoms as possible positive predictors of chronic pelvic pain. Final best-fit multivariable model found overactive bladder, fibromyalgia and presence of bowel symptoms as independent positive predictors of chronic pelvic pain. Our study is one of the few studies that has prospectively analysed chronic pelvic pain and its predictors. The present study identified significant associations with overactive bladder, fibromyalgia and bowel symptoms. Further research is needed to better understand the aetiologies of chronic pelvic pain and the possible relationship with identified clinical predictors.

Patterns of Third-Molar-Pericoronitis-Related Pain: A Morphometrical Observational Retrospective Study.

Mandibular third molar (M3M) removal and the management of postoperative complications represent a common matter of interest in oral and maxillofacial surgery. Pain represents a great symptom for patients affected by pericoronitis and it is the most common indication for third molar removal. The aim of the present article is to search for patterns of pre-operative pain in patients before undergoing third molar surgery and to test for a relation between some patterns of symptoms, such as pain intensity, site of symptomatic tooth, and referred area of pain. This retrospective observational study enrolled a total of 86 patients, aged (mean ± SD) 34.54 ± 13.62 years (range 17-78 years), scheduled for outpatient third molar extraction at the Oral Surgery School, Department of Medical Biotechnologies, Policlinico "Le Scotte", University of Siena. Pericoronitis and pain were the symptoms of the patients and the indication of extraction. Inclusion criteria were the presence of partially impacted third molars, confirmed with a preoperative panoramic radiograph, and preoperative pain. Exclusion criteria were known neurological disease (such as previous trigeminal or facial nerve injuries), impaired communicative or cognitive disease, diagnosed diabetes mellitus, and oral surgical intervention within 30 days before data collection. Patients were visited and asked to answer a morphometric analytic questionnaire about their perception of pain referred to the third molar. Analyses were performed on statistical evaluation on age, age ranges, patient gender, prior third molar extraction, site of pericoronitis, pain score (1-10), and pain area. Two-tailed p values of less than 0.05 were considered significant if not otherwise specified. No correlations were found between age, gender, previous extraction, tooth site (maxillar on mandible), pain score, and pain area. Patterns of third molar pericoronitis pain among 86 patients were reported. A significant correlation was found between pain score and pain area (p = 0.0111, rs = 0.3131). Pain intensity has indeed some kind of responsibility in determining the orofacial distribution of pain. The pain area referral patterns of the present article could be considered as a pain model resulting from the pericoronitis of maxillar and mandibular third molars.

Associations between pain, health, and lifestyle factors in 10-year-old boys and girls from a Swedish birth cohort

BackgroundPain is common in children and its associations with various biopsychosocial factors is complex. Comprehensive pain assessments could contribute to a better understanding of pediatric pain, but these assessments are scarce in literature. The aim of this study was to examine differences in pain prevalence and pain patterns in 10-year-old boys and girls from a Swedish birth cohort and to study associations between pain, health-related quality of life and various lifestyle factors stratified by sex.Methods866 children (426 boys and 440 girls) and their parents from the “Halland Health and Growth Study” participated in this cross-sectional study. Children were categorized into two pain groups, “infrequent pain” (never–monthly pain) or “frequent pain” (weekly–almost daily pain), based on a pain mannequin. Univariate logistic regression analyses, stratified by sex, were performed to study associations between frequent pain and children’s self-reports of disease and disability and health-related quality of life (Kidscreen-27, five domains), and parents’ reports of their child’s sleep (quality and duration), physical activity time, sedentary time, and participation in organized physical activities.ResultsThe prevalence of frequent pain was 36.5% with no difference between boys and girls (p = 0.442). Boys with a longstanding disease or disability had higher odds of being in the frequent pain group (OR 2.167, 95% CI 1.168–4.020). Higher scores on health-related quality of life in all five domains for girls, and in two domains for boys, was associated with lower odds of being categorized into the frequent pain group. Frequent pain was associated with poor sleep quality (boys OR 2.533, 95% CI 1.243–5.162; girls OR 2.803, 95% CI 1.276–6.158) and more sedentary time (boys weekends OR 1.131, 95% CI 1.022–1.253; girls weekdays OR 1.137, 95% CI 1.032–1.253), but not with physical activity.ConclusionsThe high prevalence of frequent pain needs to be acknowledged and treated by school health-care services and the healthcare sector in order to prevent pain from influencing health and lifestyle factors negatively in children.

Neuropathic Pain and Related Factors in Female Patients with Rheumatoid Arthritis

Purpose : Neuropathic pain (Np) can accompany Rheumatoid arthiritis (Ra)like many other diseases. Aim of our study was to investigate the frequency of Np and related factors in female patients with Ra. Methods : Age, disease duration, body mass index (BMI), erythrocyte sedimentation rate (ESR) were recorded. A pain visual analog scale (VAS) was used to record pain intensity and paindetect questionnaire (Pd) was used to record Np score. Ra disease activity was calculated with DAS28 score. Health Assesment Questionnaire (HAQ) was used for functional status. Results : Np scores of the patients were high. A significant correlation was found between Pd and VAS, BMI and HAQ values. The correlation value between Pd and disease duration, age, inflammation, disease activity was not significant Conclusion : All of the patients' pain may not be caused by inflammation. If this is the case, treatment can change. If the pain pattern is questioned and treated, unnecessary use of anti-inflammatory drugs can be prevented.

Predictive factors of success and failure for intravenous ketamine therapy in patients suffering from chronic neuropathic pain.

Intravenous (IV) ketamine is used for chronic neuropathic pain refractory to other treatments. Administration of such a medication requires high-cost services while the result is not always satisfactory with a significant percentage of failure. Success and failure are related to some factors. In this study, we aim to point the most responsive disease category to IV ketamine and the predictive factors for successful and failed treatment. Two hundred and sixty-nine patients out of 371 were included. Demographic, clinical, and therapy-related variables were retrospectively collected and then statistically analyzed using various descriptive and inferential methods. A few descriptive statistics are obtained for the variables depending on their nature (e.g., percentages for qualitative variables and means for quantitative variables). Furthermore, several inferential methods are considered to address some statistical points of interest, including, but not limited to, odds ratio interpretations via logistic regression as well as association and correlation analyses. A significant association was found between the presence of intermittent pain pattern as well as the pain of chronic primary category and favorable response to IV ketamine while the history of previous analgesic interventions was significantly associated with a negative response. The identified factors can be used to prospectively study the efficacy of ketamine using selection criteria based on the observed results in our study to re-evaluate the percentage of responsiveness according to these new parameters.

Evaluating Postoperative Pain and Pattern of Discharge Analgesia Usage After Thoracic Surgery at a Major Tertiary Level Cardiothoracic Referral Hospital

Thoracic surgery is associated with one of the highest rates of acute and chronic postoperative pain. This study aimed to assess pain management and pattern of discharge analgesia use post-thoracic surgery at 3 weeks and 3 months post-discharge.

The cervical spine in tension type headache

IntroductionThe concept that headaches may originate in the cervical spine has been discussed over decades and is still a matter of debate. The cervical spine has been traditionally linked to cervicogenic headache; however, current evidence supports the presence of cervical musculoskeletal dysfunctions also in tension-type headache. PurposeThis position paper discusses the most updated clinical and evidence-based data about the cervical spine in tension-type headache. ImplicationsSubjects with tension-type headache exhibit concomitant neck pain, cervical spine sensitivity, forward head posture, limited cervical range of motion, positive flexion-rotation test and also cervical motor control disturbances. In addition, the referred pain elicited by manual examination of the upper cervical joints and muscle trigger points reproduces the pain pattern in tension-type headache. Current data supports that the cervical spine can be also involved in tension-type headache, and not just in cervicogenic headache. Several physical therapies including upper cervical spine mobilization or manipulation, soft tissue interventions (including dry needling) and exercises targeting the cervical spine are proposed for managing tension-type headache; however, the effectiveness of these interventions depends on a proper clinical reasoning since not all will be equally effective for all individuals with tension-type headache. Based on current evidence, we propose to use the terms cervical “component” and cervical “source” when discussing about headache. In such a scenario, in cervicogenic headache the neck can be the cause (source) of the headache whereas in tension-type headache the neck will have a component on the pain pattern, but it will be not the cause since it is a primary headache.